HEALTH INFORMATION

Covers type 2 diabetes in children. Discusses how obesity or being overweight is causing type 2 diabetes in kids. Includes info on treatment. Discusses monitoring blood sugar levels. Includes info on hypoglycemia and hyperglycemia.

Covers type 2 diabetes in children. Discusses how obesity or being overweight is causing type 2 diabetes in kids. Includes info on treatment. Discusses monitoring blood sugar levels. Includes info on hypoglycemia and hyperglycemia.

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What is type 2 diabetes?

Type 2 diabetes is a
lifelong disease that develops when the
pancreas cannot make enough
insulin or when the body's tissues cannot use insulin
properly. Insulin is a hormone that helps the body's cells use sugar (glucose)
for energy. It also helps the body store extra energy in muscle, fat, and liver cells.

Without insulin, the sugar cannot get into the cells to do
its work. It stays in the blood instead. This can cause high blood sugar
levels. A person has diabetes when the blood sugar stays too high too much of
the time.

Over time, high blood sugar can cause problems with the
eyes, heart, blood vessels, nerves, and kidneys. High blood sugar also makes a
person more likely to get serious illnesses or infections.

In the
past, doctors believed that type 2 diabetes was an adult disease and that type
1 diabetes was a children's disease. Now, more and more children are getting
type 2 diabetes.

Finding out that your child has diabetes can be
scary. But your child can live a long, healthy life by learning to manage the
disease.

What causes type 2 diabetes?

Doctors do not know
exactly what causes diabetes. Experts believe the main risks for children
getting type 2 diabetes are being overweight, not being physically active, and
having a family history of the disease.

Also, the hormones
released during the early teen years make it harder than usual for the body to
use insulin correctly. This problem is called
insulin resistance. It can lead to diabetes.

What are the symptoms?

Most children with type 2
diabetes do not have symptoms when the disease is first found. If there are
symptoms, they usually are mild and may include:

Having to urinate more often.

Feeling a little more thirsty than normal.

Losing a
little weight for no clear reason.

How is type 2 diabetes diagnosed?

A simple blood
test is usually all that is needed to diagnose diabetes. Your child's doctor
may do other blood tests if it is not clear whether your child has type 1 or
type 2 diabetes.

A doctor may test your child for diabetes if he
or she is overweight, gets little physical activity, or has other risk factors
for the disease. A risk factor is anything that increases your chances of
having a disease. Some children are diagnosed with type 2 diabetes when they
have a blood or urine test for some other reason.

How is it treated?

The key to treating diabetes is
to keep your child's blood sugar levels within a target range. To do
this:

Keep track of your child's blood sugar
levels. This will help you and your child learn how different foods and
activities affect his or her blood sugar. Your doctor can teach you and your
child how to do this.

Teach your child to make healthy food
choices.

Help your child to eat about the same
amount of
carbohydrate at each meal. This helps keep your
child's blood sugar steady. Carbohydrate affects blood sugar more than other
nutrients. It is found in sugar and sweets, grains, fruit, starchy vegetables,
and milk and yogurt.

Talk to your doctor, a diabetes educator, or a dietitian
about an eating plan that will work for your child. There are many ways to
manage how much and when your child eats.

Help your child stay active. Your child does
not have to start a strict exercise program, but being more active can help
control blood sugar. For example, your child could play outside with friends,
take walks with family members, or take part in sports.

Set a good
example. It will be easier for your child if the rest of the family also eats
well and gets regular exercise. This may also reduce the risk that other family
members will get the disease.

If your child needs medicine for
diabetes, make sure that he or she takes it as prescribed.

You play a major role in helping your child take charge
of his or her diabetes care. Let your child do as much of the care as possible.
At the same time, give your child the support and guidance he or she needs.

The longer a person has diabetes, the more likely he or she is to
have problems, such as diseases of the eyes, heart, blood vessels, nerves, and
kidneys. But if your child can control his or her blood sugar levels every day,
it may help to delay the start of or prevent some of these problems later
on.

Even when you are careful and do all the right things, your
child can have problems with high or low blood sugar. It is important to know
what signs to look for and what to do if this happens.

Can type 2 diabetes be prevented?

Helping your
child stay at a healthy weight and get regular exercise can help prevent type 2
diabetes.

Cause

The exact cause of
type 2 diabetes is not known. But experts believe the
disease develops in children the same way it does in adults. The body does not
produce enough of the hormone
insulin, or it cannot correctly use the insulin
available (insulin resistance). Either or both of these
conditions lead to excess sugar (glucose) in the blood.

Insulin resistance

Insulin resistance occurs when
the body's cells do not correctly use insulin, which helps control the amount
of glucose in the blood. The body then needs more insulin to control blood
sugar levels. The
pancreas produces more insulin to try to keep blood
sugar levels normal. If it cannot produce enough insulin, blood sugar rises,
and diabetes may develop.

Things that affect the body's
resistance to insulin in childhood include:

Developmental stage. Growth hormone released during
puberty can make it harder than usual for the body to use insulin correctly.

Being female. Girls seem
to develop more resistance to insulin than boys.

Activity. Exercise may improve how the
body's cells use insulin and get the sugar they need.

Too little insulin

Normally, the pancreas produces
more insulin than usual during puberty to support the rapid growth of the
child. If the body cannot produce enough insulin to meet its needs, diabetes
develops. Over time, the pancreas may produce less and less insulin, making the
diabetes worse.

Symptoms

Children often have no symptoms of
type 2 diabetes before they are diagnosed, because
their blood sugar level has been rising so slowly. As a result, a child may
have diabetes for several months or years before being diagnosed.

When children do have symptoms, the most common include:

Slight increase in the frequency of urination.
Your child may have started
wetting the bed at night.

Slight increase in
thirst.

Other possible symptoms include:

Increased
tiredness.

Nausea.

Blurred vision.

Frequent
infections and slow-healing wounds or sores.

Weight loss.

What Happens

Type 2 diabetes
usually develops in adulthood, but the number of children being diagnosed with
the disease is rising. Children with type 2 diabetes are usually diagnosed
during the early teen years. During this time, their bodies are growing and
developing rapidly, placing a demand on the
pancreas to produce additional
insulin.

The hormones released during
puberty can make it harder than usual for the body to use insulin correctly
(insulin resistance). Also, children with type 2
diabetes are usually overweight, which also contributes to insulin resistance.
If the pancreas cannot produce enough insulin to overcome the resistance,
diabetes can develop.

Diabetes experts believe the disease progresses as it
does in adults. The main risk factors for complications from diabetes are the length of time a person
has diabetes and the degree of blood sugar control. A child who develops type 2
diabetes may have an increased risk of complications, because he or she will
have the disease for a long time. Some complications that children and teens may develop include:

If a child's blood sugar levels remain high for a long
time, he or she may grow at an abnormal rate—faster than normal for a while,
then slower than normal later. If blood sugar levels stay high during puberty,
normal changes and the start of menstruation may be delayed.

The way to prevent complications is to always keep blood sugar levels in a target range. This requires that your child follow his or her treatment plan
daily and monitor blood sugar levels often. Your child also will need ongoing
diabetes education and regular checkups. Other medical conditions, such as high
blood pressure and high cholesterol, need adequate medical care also, because
they raise the risk for diabetes complications.

Children with type
2 diabetes have to modify their lifestyles. Your child will be more successful
if your whole family is involved. These lifestyle changes benefit everyone by
reducing the risk for diabetes and heart
disease.

What Increases Your Risk

The major risk factors for
type 2 diabetes in children include:

Being overweight.

Getting little or no physical activity.

Having a parent, sister,
or brother with the disease.

Other things that increase risk include:

Race. African-American, Hispanic, Native
American, Asian-American, and Pacific Islander children are at greater risk for
type 2 diabetes than white American children.

Being
female. Girls are more likely to develop the disease than boys.

The
child's mother having diabetes that developed during pregnancy (gestational diabetes).

Watchful waiting

Watchful waiting is a period of time during
which you and your doctor observe your child's symptoms or condition without
using medical treatment. Watchful waiting is not
appropriate if:

You think your child may have symptoms of
type 2 diabetes. A simple blood test is all that is needed to determine whether
your child has the disease.

Your child is overweight and gets
little or no exercise. He or she is at risk for diabetes. Early
detection and treatment for type 2 diabetes can prevent or delay complications
from the disease.

You have been told that your child has
prediabetes. This condition can lead to type 2
diabetes. If your child eats a healthy diet and exercises regularly, he or she
may not develop diabetes.

Who to see

Most doctors can diagnose diabetes. After your child
has been diagnosed, your doctor will work with you to build a treatment plan
that fits your child's needs. Health professionals who may be involved in the
treatment of children with type 2 diabetes include:

A
certified diabetes educator (CDE). A CDE is a
registered nurse, dietitian, doctor, pharmacist, or other health professional
who has special training and experience in caring for people with
diabetes.

Exams and Tests

Many children have had no symptoms
before they are diagnosed with
type 2 diabetes. Usually, the illness is discovered
when a blood or urine test taken for another reason shows diabetes.

If a doctor suspects that your child may
have type 2 diabetes, he or she will do a
medical history,
physical exam, and blood glucose testing. If
the results of these tests meet the
criteria for diagnosing diabetes established by the
American Diabetes Association (ADA), your child has diabetes.

Other possible tests

If it is hard to tell whether
your child has type 2 or
type 1 diabetes, your doctor may do a
C-peptide test or an autoantibodies test.
(Autoantibodies are produced when the body's
immune system does not work right.) These tests may
not be able to confirm the type of diabetes your child has. Getting a
definite diagnosis may take months or years. In either case, your child's sugar
levels will need to be controlled right away.

Sometimes a doctor
will do a quick
home blood sugar test or a
urine test for sugar to see whether a child may have
diabetes. Although these tests are simple and can show possible diabetes,
additional testing is needed to make sure your child actually has the
disease.

Monitoring tests if diagnosed with diabetes

Because your child is at risk for diabetes complications (eye, heart,
kidney, nerve, liver, and blood vessel problems), he or she needs to see a
doctor regularly for tests to monitor type 2 diabetes.

Early detection

If your child is overweight and gets little or no exercise, he or she may be at risk for type 2 diabetes. Early detection
and treatment for type 2 diabetes can prevent or delay problems from the disease.

Treatment Overview

Treatment of
type 2 diabetes in children focuses on keeping blood
sugar levels within a
target range. Children may need higher blood sugar
goals than adults, because their bodies are still developing. Also, they may not
be able to recognize symptoms of
low blood sugar. To reach his or her target blood
sugar, your child needs to eat healthy meals of appropriate portion size and
get daily exercise. Treatment also may include medicine.

Healthy eating

A healthy diet with the right
amount of calories will help your child achieve target blood sugar levels and
maintain a healthy weight. The meal plan designed for your child will spread
carbohydrate (starches and sugary foods) throughout
the day. This helps prevent high blood sugar after meals as well as weight
gain. A registered dietitian can design a meal plan that not only fits your child's
needs but also is a healthy eating plan for your family. For more information, see the topic
Healthy Eating for Children.

Weight management

If your child is overweight, he or she may need to lose weight (or stay at the same weight and not gain more). This depends on his or her age, development, and other risk factors.

Being physically active

Physical activity is
extremely important. It helps the body use insulin correctly and helps control
weight. Your child does not have to start a rigorous exercise program, but
being more active can help control blood sugar. For example, your child could
play outside with friends, take brisk walks with family members, and
take part in individual or team sports.

Experts recommend that
teens and children (starting at age 6) do moderate to vigorous activity at
least 1 hour every day.1 And 3 or more days a week,
what they choose to do should:

Make them breathe harder and make the heart
beat much faster.

Make their muscles stronger. For example, they
could play on playground equipment, play tug-of-war, lift weights, or use
resistance bands.

Make their bones stronger. For example, they
could run, do hopscotch, jump rope, or play basketball or tennis.

It's okay for them to be active in smaller blocks of time
that add up to 1 hour or more each day.

Limit your child's screen time. Have your child take breaks from computer, cell phone, and TV use and be active instead.

Medicines

Your child may need medicines if eating healthy meals and getting regular physical activity have not
lowered your child's blood sugar to his or her target level.

Medicines for diabetes help the body
produce more insulin, decrease the body's
resistance to insulin, or slow the absorption of
carbohydrate from the intestine. Your child may need one medicine at some times
and more than one at other times.

Some children need daily
insulin shots—alone or with other medicines. Even if
your doctor does not prescribe daily insulin, your child may need to take
insulin temporarily when first diagnosed or during illness or surgery. If the
progression of diabetes cannot be stopped, your child eventually may need to
take insulin daily.

Checking blood sugar, blood pressure, and cholesterol

Your child's blood sugar level may need to be checked regularly, for example, before breakfast and 2 hours after meals.

If your child has high blood pressure or high cholesterol, those
conditions need to be treated.

Weight loss and
well-controlled blood sugar can help lower your child's cholesterol. Your
child's doctor may recommend medicine if these lifestyle changes do not lower
cholesterol. Sexually active teens should be warned against becoming pregnant
while taking these medicines.

What to think about

Some children have very high
blood sugar levels when they are diagnosed with type 2 diabetes. A child with a
very high blood sugar level may develop the serious chemical imbalance
diabetic ketoacidosis and need to be treated with
insulin in a hospital. After blood sugar returns to a target level, the child
usually no longer needs insulin. His or her own body may start making enough
insulin again.

Treating diabetes with medicine increases the risk for
low blood sugar episodes. Your child's doctor will determine
the target range for your child's blood sugar that will prevent damage from diabetes
while causing as few low blood sugar episodes as possible.

The
lifestyle changes needed to control diabetes can be especially hard for
a child or teen. Your child will have a better chance of being successful if
the whole family is involved. Eating a healthy diet and getting regular
exercise may help other family members avoid diabetes.

Teens who have
depression or an
eating disorder may have difficulty keeping their
blood sugar at a healthy level. Also, teens who smoke or use alcohol or
other drugs have problems with blood sugar control. Support groups may help
teens deal with diabetes management issues, which can improve the teens'
perception of diabetes care and blood sugar control.

Prevention

Healthy meals, physical activity, and
weight control can help prevent diabetes or can prevent or delay complications
if your child has diabetes. A
registered dietitian can help you build a healthy meal
plan for your child. Your doctor, exercise specialist, or
certified diabetes educator also can help your child
find ways to become more physically active.

Having a blood sugar level that is higher than normal but not yet at the
level of diabetes (prediabetes) increases a child's risk for type 2
diabetes. If your child
has prediabetes, eating a healthy diet and increasing physical exercise may
make his or her blood sugar return to a normal range and possibly prevent type
2 diabetes. Your child will still need to see a doctor regularly to check for
signs of the disease.

Home Treatment

Healthy eating

Your child needs to eat healthy
meals with appropriate portions to support growth and prevent weight gain. The
meal plan for your child will also spread
carbohydrate throughout the day to prevent high blood
sugar after meals. For information on healthy eating and weight management, see
the topic
Healthy Eating for Children.

Physical activity

Encourage your child (age 6 to
17) to do moderate to vigorous activity at least 1 hour every day. Limit the amount of time your child watches TV and uses the computer and cell phone. You can help your child or teen be active by looking for ways to make activity more fun and by being active along with your child.

For children age 2 and older: The
American Academy of Pediatrics advises parents to limit screen time to 2 hours a
day or less. And it's best for children younger than 2 to not watch TV, watch movies, or play games on a screen.

Work with your child's teachers and school to
make a plan to handle your child's special needs, including testing blood sugar
and eating snacks when needed.

Your child can take part in the same activities as other
children. For safety:

Let the coach know that your child has
diabetes. If your child doesn't take insulin, he or she may not be at risk for
low blood sugar episodes. But making sure that the coach knows the symptoms of low blood sugar may still be a good
idea.

Take your child's
home blood sugar meter to sports practice sessions and
games. Check his or her blood sugar level before and after each activity, if
needed.

Home blood sugar monitoring

You and your child
will need to monitor his or her blood sugar frequently to know how well it is
under control. Talk with your doctor about a target range for
your child. Young children may need a higher blood sugar goal than adults
because of growth needs and to prevent very low blood sugar (hypoglycemia). As
your child grows older, the goal can be lowered so that it is closer to the
recommended
target range.

Insulin injections

Your child may not need to take
insulin if his or her blood sugar levels are staying within a target range with
meal planning, exercise, and possibly other medicine. But at some point your
child may need to take insulin because the
pancreas may produce less and less insulin.

If your child takes insulin, you and your child need to know how to
prepare and give a shot.

How to recognize and treat low blood sugar. Your child is not
likely to have a sudden drop in blood sugar level unless he or she is taking
sulfonylurea or meglitinide medicines for diabetes or insulin injections and is
unable to eat regular meals.

Wearing
medical identification at all times. In an emergency, medical identification
lets people know that your child has diabetes so they can care for your child
appropriately.

Where to get support. Many areas of the country have
support groups for children and teens with diabetes and for family members.
These groups provide encouragement and suggestions that may help you and your
child deal with the daily issues of diabetes care. Talk with your doctor about
groups in your area.

How to care for the feet. Your child needs to
wear shoes that fit properly. He or she should not go barefoot outdoors. It's a good idea to begin the habit of inspecting your child's feet periodically or any time he or she has a foot complaint. Look for signs of injury or infection. If you notice a
foot problem, even a minor one, talk with your doctor before treating
it.

What to do for illness. Some general
sick-day guidelines may be helpful. These include
checking your child's blood sugar every 4 hours during the illness and
encouraging your child to drink fluids to prevent dehydration. Do not give your
child any
nonprescription medicines without talking with a
doctor or pharmacist. Some of these medicines can affect blood sugar
levels.

What to think about

Childhood and the teen years
are a difficult time to be diagnosed with diabetes. Normal developmental
changes may interfere with your child following his or her treatment.
Teens with diabetes may rebel against
treatment or participate in risky behavior, such as using drugs or drinking
alcohol.

You play a major role in helping your child become
independent in his or her diabetes care. Allow your child to do as much of the
care as possible. But give your child the support and guidance he or she
needs. Your child will be more successful if your family is physically active and has healthy eating habits.

Children in elementary school can cooperate
in all tasks required for their care. By age 8, children can test their own
blood sugar if they are supervised.

Children in middle school or junior
high school should be able to test their own blood sugar, but they may need
help during low blood sugar episodes. By age 10, some children can give insulin
injections if they are supervised.

With appropriate supervision, teens should be able to handle their
care. If the teen needs to take insulin, he or she
may choose to use an
insulin pump instead of injections. If your teen
chooses to use a pump, be sure to supervise.

Medications

The same medicines are used to treat
adults and children with
type 2 diabetes. These medicines increase
insulin production, make the body better able to use
insulin (decrease
insulin resistance), or slow the intestinal absorption
of
carbohydrate.

Sometimes a child needs
more than one medicine to adequately control diabetes. Two or more medicines
taken together may work more effectively than a single medicine. Taking two
medicines together also may reduce possible side effects by allowing lower
doses of each. But in some cases, taking two medicines can increase the risk of
certain side effects, such as low blood sugar (hypoglycemia).

Some children need daily
insulin shots—alone or with other medicines. Even if your doctor does not
prescribe daily insulin, your child may need to take insulin temporarily when
first diagnosed or during illness or surgery. At some point in adulthood, he or
she will likely need insulin, because over time the
pancreas does not produce enough insulin. Insulin also
may be needed during pregnancy and breast-feeding.

If your child
has
high cholesterol or
high blood pressure, medicine for those conditions may
be needed. Even blood pressure slightly above normal increases the risk for eye
and kidney damage from diabetes.

Medicine choices

Medicines that decrease insulin resistance:

Biguanides, such as metformin
and other medicines that are combined with metformin

Statins may be used if a healthy diet and physical
activity do not lower cholesterol. Sexually active teens should be warned
against becoming pregnant while taking these medicines.

What to think about

Metformin is the medicine of choice
for children with type 2 diabetes. It usually keeps blood sugar levels within a
target range without increasing the likelihood that
the child will gain weight. If after 3 to 6 months of treatment with metformin
the child's blood sugar levels are not consistently within a target range,
other medicine usually is added.

Insulin may be given as a single
nighttime dose, as several smaller doses throughout the day, or both. Insulin
doses for children with type 2 diabetes are usually high—to overcome the body's
resistance to insulin—which may increase the risk for
weight gain.

Although
alpha-glucosidase inhibitors are safe for children,
they may cause abdominal gas, making them less acceptable to teens than other
diabetes medicines.

Surgery

When obesity is severe in older adolescents
with
type 2 diabetes, gastric bypass or other similar
surgery may be considered as a last resort. For more information, see the topic
Obesity.

Other Treatment

Children who have
type 2 diabetes should not try to lose weight by
following a fad diet or by enrolling in a quick-fix weight loss program. Most
doctors recommend that overweight children eat a healthy diet that provides
appropriate calories to prevent further weight gain.

Weight loss
is appropriate if your child is overweight and he or she has reached adult
height. In some severe cases, weight loss before your child reaches his or her
full adult height may be needed.

Other types of treatment for diabetes are provided by therapists or
others who do not operate within mainstream medical practice. None of these
complementary therapies have been proved to be effective in treating diabetes.
But your child may benefit from safe, nontraditional therapies that complement
conventional medical treatment for the disease. Talk with your doctor before
seeking any complementary therapies for your child.

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